Developing a Professionalism and Harassment Policy for Organized Neurosurgery.

Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined forces to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.

Developing a professionalism and harassment policy for organized neurosurgery.

Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.

A medical-legal perspective on overlapping surgery.

In the U.S., there has recently been increased scrutiny on the appropriateness of surgeons performing overlapping cases and the potential for adverse consequences. This article describes the current literature on overlapping surgery and the ethics that guide behavior by performing a review of the PUBMED literature on overlapping surgery and analysis. Although the literature on overlapping surgery supports it as a safe practice, some public opinion runs contrary to the data, which is driving changes in policy. Surgeons should become familiar with the overlapping surgery policy in the hospital(s) in which they practice and be mindful of the potential consequences of performing overlapping surgeries.

Neurosurgeon transition to retirement: results of the 2007 Congress of Neurological Surgeons Consensus Conference.

OBJECTIVE: Recent studies of age-related effects on cognition and performance have raised concerns about the appropriate timing and regulatory surveillance of retirement for surgeons. Little is known about the practice patterns and retirement plans of aging neurosurgeons. Analyses of informed opinions on possible regulatory options are also lacking. METHODS: During a consensus development workshop conducted at the 2007 Annual Meeting of the Congress of Neurological Surgeons, participants collected data regarding neurosurgeons' retirement plans, reviewed expert background information, and assessed opinions. Participants submitted data and discussion points throughout the session using digital handheld devices. These data were then statistically analyzed, with particular attention to shifts in opinion and emergence of consensus after the presentation of expert material and discussion. RESULTS: Neurosurgeons strongly oppose government regulation of retirement using uniform retirement age regulations. The most favored policy option, initially, particularly among older neurosurgeons, was status quo. After consensus development, the most favored policy option was local regulation by hospital privileging bodies. Neurosurgeon age, but not perceived ability to reach financial retirement goals, significantly influenced opinions. CONCLUSION: Retirement age is an area of active government regulation in other professions. Neurosurgeons seem to favor a flexible system of regulation based on local and quality standards, rather than national age-based thresholds. The Congress of Neurological Surgeons Consensus Conference process offers a viable methodology for initiating discussion of important policy issues facing organized neurosurgery, engaging the informed input of practicing neurosurgeons, and formulating preliminary strategies for pursuit by stakeholder neurosurgical policy organizations.

Providing expert witness testimony.

The frequency of medical malpractice litigation in neurosurgery creates an opportunity for those in the profession to provide their opinion to courts on professional standards of care in the form of expert witness testimony. Providing expert witness testimony in a thorough and objective manner is difficult. This paper discusses the process of providing expert witness testimony as well as techniques the neurosurgeon can use to testify more effectively.

Informed consent for the neurosurgeon.

Obtaining informed consent from patients contemplating neurosurgical procedures is an important process in preoperative care. A surgeon's failure to fulfill his or her legally prescribed duty to inform the patient and obtain consent can result in unnecessary exposure to liability. This paper describes the legal background, doctrine, and elements of informed consent. It also outlines the dialog that should legally take place between physician and patient before a planned procedure and discusses special circumstances that may affect the informed consent process.

Physician reimbursement under Medicare.

Payment for physician services in the United States is directly tied to the payment system implemented in the Medicare system. The use of a code to categorize medical and surgical services, as well as a relative value system to assess physician services and reimburse them accordingly, is now well established. In light of this, it is important for physicians to possess knowledge of how this coding and reimbursement system was established, how it is updated, what means are available to modify it, and how it is used in practice. The author addresses these issues, offering a primer for the neurosurgeon on the Medicare system as it relates to physician payment.